The Dietary Guidelines for Americans (2020–2025): Pulses, Dietary Fiber, and Chronic Disease Risk—A Call for Clarity and Action

The 2020–2025 Dietary Guidelines for Americans (DGA) were recently released [...]

Compliance with dietary guidelines and its relationship with symptoms and clinical outcomes in patients with advanced cancer in early-phase oncology clinical trials.

199 Background: We examined compliance with the Dietary Guidelines for Americans and its association with symptom burden and clinical outcomes in patients with advanced cancer in early-phase clinical trials testing novel immunotherapeutic and targeted agents. Methods: Patients starting an early-phase clinical trial (ECOG-PS = 0-1) were recruited into a prospective, longitudinal design with assessments at baseline and at the end of Cycle 1. Diet and symptom burden were assessed using the validated National Cancer Institute Diet History Questionnaire (NCI-DHQ) and the MD Anderson Symptom Inventory, respectively. Compliance with the Dietary Guidelines for Americans recommendations was measured via the Healthy Eating Index (HEI) (a measure of dietary intake per total energy), computed from NCI-DHQ food group and nutrient scores; higher HEI scores indicate greater compliance with dietary guidance recommendations (possible range = 0–100). Statistical tests included Spearman rank correlations (rho), and Cox proportional hazards models. Results: Among early-phase clinical trial patients [N = 40; 50% female; 80% Non-Hispanic White; 80% ECOG = 1; 36% on trials including an immunotherapeutic agent and 64% on targeted therapy trials; mean age = 55y; mean BMI = 28], mean HEI was 69, compared to 59 for the US general population. The proportion of phase I clinical trial patients who met adequacy guidelines were 80% for whole fruit, 73% for total protein foods, 55% for seafood and plant proteins, 55% for total fruit, 50% for greens and beans, 28% for total vegetables, 15% for fatty acids [(PUFAs + MUFAs)/SFAs ≥2.5], 13% for dairy, and 0% for whole grains. The proportion of patients who met moderation guidelines were 28% for refined grains, 28% for added sugar, 13% for saturated fat, and 0% for sodium. Female patients had higher HEI scores than male patients (73 vs. 65, P = 0.004). Patients who were normal weight (BMI < 25) had higher scores for meeting the moderation in sugar intake guideline than overweight patients (BMI≥25) (7.7 vs. 5.5, P = 0.031). Higher intakes of cooked lean meat from beef, pork, veal, lamb, and game were linked to prolonged overall survival (HR = 0.5, 95%CI = 0.26, 0.96, P = 0.039). In immunotherapy patients, greater compliance with seafood and plant protein recommendations was associated with less fatigue at end of Cycle 1 (rho = -0.7, P = 0.008); in targeted therapy patients, higher glycemic load was associated with worse pain (rho = 0.7, P = 0.004). Conclusions: Diets of these early-phase clinical trial patients overall were congruent with recommendations in the Dietary Guidelines for Americans. However, increasing intakes of whole grains and reducing sodium intakes may be useful dietary goals for this population. Also, dietary factors may influence symptoms, such as fatigue and pain, in early-phase clinical trial patients with advanced cancer.

An 8 week randomized Dietary Guidelines for Americans -based diet intervention improves the omega-3 index of healthy women

Background: The Dietary Guidelines for Americans (DGA) recommends consuming >1.75g/wk of long-chain omega-3 fatty acids to reduce the risk of cardiovascular disease (CVD) through triglyceride reduction, however individual responses to treatment vary. Objective: We sought to determine if a DGA-conforming diet (DGAD) can increase the omega-3 index (OM3I), a diet-sensitive biomarker of omega-3 fatty acid status, into a health promoting range and reduce fasting triglycerides in 8 weeks. We further explored determinants of the basal OM3I and its response to treatment. Design: This is a secondary analysis of a randomized, double-blind 8wk dietary intervention of overweight/obese women fed an 8d rotating DGAD (n =22) or typical American diet (TAD; n =20) registered at www.clinicaltrials.gov as NCT02298725. The DGAD and TAD provided individuals with 16 ± 2 g/wk and 1.2 ± 0.12 g/wk of eisocapentaenoic acid (EPA) + docosahexaenoic acid (DHA), respectively. Habitual diet and body composition were determined at baseline. OM3I, fasting triglycerides, glucose and insulin were measured at 0, 2 and 8wk. Results: Baseline OM3I (5.8 ± 1.3; n =42) was positively correlated to the dietary (EPA+DHA):dietary fat ratio (p =0.006), negatively correlated to the android fat mass (p =0.0007) and was not different between diet groups. At 8wk, while the TAD-group average OM3I was unchanged (5.8 ± 0.76), the DGAD-group OM3I increased (7.33 ± 1.36; p <0.001). In the DGAD-group 9 of 22 (i.e. 41%) participants achieving an OM3I >8%. Subgroup analyses of the DGAD-group revealed that body fat content and distribution influenced the baseline-dependent response to treatment. Fasting triglyceride and OM3I changes did not correlate. Conclusions: An 8wk TAD stabilized the OM3I in a healthy range, while a DGAD increased the OM3I into a health-promoting range, but did not reduce fasting triglycerides. Fat distribution and basal omega-3 status are primary factors influencing omega-3 efficacy in overweight/obese women.

Dietary Saturated Fats and Health: Are the U.S. Guidelines Evidence-Based?

The last decade has seen nearly 20 papers reviewing the totality of the data on saturated fats and cardiovascular outcomes, which, altogether, have demonstrated a lack of rigorous evidence to support continued recommendations either to limit the consumption of saturated fatty acids or to replace them with polyunsaturated fatty acids. These papers were unfortunately not considered by the process leading to the most recent U.S. Dietary Guidelines for Americans, the country’s national nutrition policy, which recently reconfirmed its recommendation to limit saturated fats to 10% or less of total energy intake, based on insufficient and inconsistent evidence. Continuation of a cap on saturated fat intake also fails to consider the important effects of the food matrix and the overall dietary pattern in which saturated fatty acids are consumed.

Low-Carb/High-Fat/Fried-Food Diet: The Surprising Effects in Triglycerides, Lipid Profile, and Glycemia in a Patient with a Metabolic Syndrome

We continuously underestimate the eating process: food and cooking methods play a pivotal role in our health. According to the Dietary Guidelines for Americans (DGA), more than 117 million American adults have one or more preventable chronic diseases, many of which are related to poor quality eating patterns and physical inactivity. Despite the usual belief about fat in the diet, it has shown that fat has a uniquely positive effect on blood lipid concentrations and cardiovascular risk factors. A low-carb/high-fat/fried-food (LCHFFF) diet has shown to be one of the best natural treatments in lipid profile and glycemia in a patient with metabolic syndrome.

Toward an Evidence-Based Definition and Classification of Carbohydrate Food Quality: An Expert Panel Report

Carbohydrate-containing crops provide the bulk of dietary energy worldwide. In addition to their various carbohydrate forms (sugars, starches, fibers) and ratios, these foods may also contain varying amounts and combinations of proteins, fats, vitamins, minerals, phytochemicals, prebiotics, and anti-nutritional factors that may impact diet quality and health. Currently, there is no standardized or unified way to assess the quality of carbohydrate foods for the overall purpose of improving diet quality and health outcomes, creating an urgent need for the development of metrics and tools to better define and classify high-quality carbohydrate foods. The present report is based on a series of expert panel meetings and a scoping review of the literature focused on carbohydrate quality indicators and metrics produced over the last 10 years. The report outlines various approaches to assessing food quality, and proposes next steps and principles for developing improved metrics for assessing carbohydrate food quality. The expert panel concluded that a composite metric based on nutrient profiling methods featuring inputs such as carbohydrate–fiber–sugar ratios, micronutrients, and/or food group classification could provide useful and informative measures for guiding researchers, policymakers, industry, and consumers towards a better understanding of carbohydrate food quality and overall healthier diets. The identification of higher quality carbohydrate foods could improve evidence-based public health policies and programming—such as the 2025–2030 Dietary Guidelines for Americans.